ABSTRACT
Maternal health is one of the major concerns of the global health community. Pregnancy- related mortality is avoidable if preventive measures are taken and adequate care is available. Yet women in sub-Saharan Africa continue to die due to pregnancy-related complications. This study set out to examine the socio-cultural context of pregnant women and how that context precipitates maternal morbidity and mortality. The study was prompted by the high rate of maternal death despite all efforts and the observation that studies had concentrated on the proximate determinants of maternal mortality, rather than also considering the social determinants. Five objectives were considered which were to: identify the social factors that precipitate the medical proximate determinants of maternal health, determine the cultural beliefs and stereotypes that are associated with maternal health, examine how role conflict influences maternal health, investigate how mothers’ working conditions affect maternal health, and evaluate how social support influence maternal health. Systematic review of literature was carried out while the study utilized Functionalism, Agency Structure Theory and Gender and Development (GAD) Theory for its theoretical framework. The study was conducted in the four selected Local Government Areas (LGAs) of Lagos State from November, 2011to January, 2012 using 1,362 respondents to whom a structured questionnaire was administered, 20 key informants were interviewed and 4 case studies were analysed. Five hypotheses were tested. The first hypothesis revealed age, education, occupation, income, religion, marital status and type of marriage are significant determinants of maternal health complications. Women in age group 20-24, 25-29 and 30-34 are 0.631, 0.621 and 0.756 respectively less likely to have health complications. The second hypothesis estimated significant influence of cultural beliefs and practices on maternal health. With p-values 0.021, 0.001, 0.050 and 0.011 respectively, women who experience swollen feet, dizziness, fatigue or more than one of these symptoms are more likely to be at risk of complication. The third hypothesis also indicated a significant influence of role conflict on maternal health. Women’s working conditions were found to significantly influence maternal health complications in the forth hypothesis. And the finding of the fifth hypothesis revealed that there is a significant influence of social support availab le to women on maternal health. The findings presented in this study show that maternal health
challenges will continue to shape national indicators on health, poverty, and other development issues, if adequate attention is not provided. The study suggests that to reduce maternal morbidity and mortality, intervention programmes must be introduced to deal with maternal health in a broad and multidimensional way. Every effort must be put in place to reduce poverty and enhance infrastructural development. Health promotion and education should be widely recognized and should be embarked upon as necessary primary approaches to ensure maternal health. Health policies toward maternal wellbeing during pregnancy in the place of work should be developed in the light of urban poor infrastructure. There must be a strong political will to help in the process of reducing maternal mortality in Nigeria.
Keywords: Socio-cultural, Maternal health, Complications, Lagos.
TABLE OF CONTENTS
Title page……………………………………………………………………………………………………….. i
Certification…………………………………………………………………………………………………… ii
Dedication…………………………………………………………………………………………………….. iii
Acknowledgements……………………………………………………………………………………….. iv
Abstract……………………………………………………………………………………………………….. vii
Table of Contents…………………………………………………………………………………………… viii
List of Tables………………………………………………………………………………………………… xiii
List of Figures………………………………………………………………………………………………. xv
Abbreviations………………………………………………………………………………………………. xvi
CHAPTER ONE: Introduction
- Background to the Study………………………………………………………………………….. 1
- Statement of the problem………………………………………………………………………….. 4
- Research Questions…………………………………………………………………………………… 7
- Aim and Objectives of Study…………………………………………………………………….. 7
- Justification for the Study…………………………………………………………………………. 8
- Operational Definition Terms……………………………………………………………………. 10
1.8 Organization of Chapters…………………………………………………………………………….. 11
CHAPTER TWO: Literature Review and Theoretical Framework
- Introduction………………………………………………………………………………………………… 12
- Global Action on Maternal Mortality……………………………………………………………….. 27
- International Conference on Population and Development (ICPD) 1994……………… 28
- Global Action on Maternal Mortality……………………………………………………………….. 27
2.6.3 Synthesis……………………………………………………………………………………………………….. 65
CHAPTER THREE: Methods of Study
- Introduction…………………………………………………………………………………………………….. 74
- The Study Area……………………………………………………………………………………………….. 74
3.6.2.Procedure for Data Collection……………………………………………………………………………… 93
CHAPTER FOUR: Data Presentation and Analysis
- Introduction……………………………………………………………………………………………………. 102
- Demographic Data…………………………………………………………………………………………… 102
- Demographic Characteristics of Respondents……………………………………………………… 102
- Demographic Data…………………………………………………………………………………………… 102
4.1.2 Spouse’s Demographic Characteristics………………………………………………………………… 107
- Research Questions………………………………………………………………………………………….. 108
- Socio-economic Factors that Precipitate the Medical Proximate Determinants of
Maternal Health………………………………………………………………………………………………. 108
- Cultural Beliefs, Stereotypes and Maternal Health………………………………………………… 111
- Multivariate Analysis………………………………………………………………………………………… 117
- Logistic Regression Estimating the Influence of Socio-demographic Factors on
- Multivariate Analysis………………………………………………………………………………………… 117
the odds of maternal health………………………………………………………………………………… 117
- Logistic Regression Estimating the Influence of Cultural Beliefs and Stereotypes
on the Odds of Experiencing Maternal Health Complication…………………………………. 122
- Logistic Regression Estimating the Influence of Role Conflicts on the
Odds of Experiencing Maternal Health Complication……………………………………………. 124
- Logistic Regression Estimating the Influence of Working Conditions on the
Odds of Experiencing Maternal Health Complications………………………………………….. 126
- Logistic Regression Estimating the Influence of Social Support on the
Odds of Maternal Health Complications……………………………………………………………… 131
Chapter Five: Summary, Conclusion and Recommendations
- Introduction…………………………………………………………………………………………………….. 149
- Contribution of the Study to Body of Knowledge………………………………………………… 156
References……………………………………………………………………………………………………………….. 158
Appendix I: Questionnaire Schedule………………………………………………………………………….. 181
Appendix II: Key Informant Interview Guide (For Medical Practitioners)……………………… 189
Appendix III: Key Informant Interview Guide (For Women Ages 15-49)………………………… 190
Appendix IV: Maternal Mortality Rate in Lagos State……………………………………………………. 192
Appendix V: List of State-Owned Health Institutions and Registered Private
Health Facilities in Lagos State…………………………………………………………….. 193
Appendix VI: Population Figure of Lagos State…………………………………………………………. 194
Appendix VII: Photographs……………………………………………………………………………………… 195
LIST OF TABLES
Table 2.1: Derivation of Actual Achievements on MDG 5 from Target…………………………….. 30
Table 3.1: Results of 2010 Maternal Mortality Study for the 20 Local Government
Areas (LGAs) of Lagos State, Nigeria……………………………………………………………. 80
Table 3.2: Distribution of Selected EAs in each of the LGAs and Streets
in each of the EAs……………………………………………………………………………………………… 81
Table 3.3: Distribution of Health Facilities in the Study LGAs………………………………………… 88
Table 3.4: Ratio of Health Facility to Total Population…………………………………………………….. 89
Table 4.1: Distribution of Respondents’ by Demographic Characteristics………………………….. 105
Table 4.2: Distribution of Respondents by Type of Marriage Contracted,
Age at Marriage, and Position among Wives………………………………………………… 106
Table 4.3: Demographic Characteristics of Spouses……………………………………………………….. 107
Table 4.4: Health Complication during Pregnancy………………………………………………………….. 108
Table 4.5: Cross Tabulation of Socio-economic Factors and Period of Pregnancy
before Antenatal Visit……………………………………………………………………………….. 110
Table 4.6: Cross Tabulation of how Cultural Beliefs and Stereotypes affect
Maternal Health…………………………………………………………………………………………. 112
Table 4.7: Frequency Distribution by Role Conflict……………………………………………………… 113
Table 4.8: Role conflict influence on maternal health……………………………………………………. 114
Table 4.9: Working conditions that influence maternal health………………………………………… 115
Table 4.10: Social Support Influence on Maternal Health………………………………………………… 116
Table 4.11: Odds Ratio of Logistic Regression on the Influence Social-demographic
factors on Proximate Determinants of Maternal Health Complications…………….. 121
Table 4.12: Logistic Regression Estimates of the Influence of Cultural Beliefs
and Stereotypes on the Odds of Experiencing Maternal Health Complication….. 124
Table 4.13: Logistic Regression Estimates of the Influence of Role Conflicts
on Maternal Health……………………………………………………………………………….. 125
Table 4.14: Logistic Regression Estimates of the Influence of Working Conditions
on Maternal Health……………………………………………………………………………….. 130
Table 4.15: Logistic Regression Estimates of the Influence of Social Support
on Maternal Health………………………………………………………………………………… 133
LIST OF FIGURES
Figure 2.1: Schematic Representation of the Conceptual Framework……………………………….. 70
Figure 3.1 Map of Lagos State…………………………………………………………………………………… 77
Figure 4.1: Frequency of the Proximate Determinants of Maternal Health………………………… 108
LIST OF ABBREVIATIONS
EOC | Emergency Obstetric Care |
HEFAAMA | Lagos State Health Facility Monitoring and Accreditation Agency |
HDR | Human Development Report |
ICD | International Classification of Diseases |
ICM | International Conference of Midwives |
ICRW | International Centre for Research on Women |
MMR | Maternal Mortality Rate |
NDHS | Nigeria Demographic and Health Survey |
NPCN | National Population Commission Nigeria |
PHC | Primary Health Care |
TBA | Traditional Birth Attendant |
UN | United Nations |
UNDP | United Nations Development Programme |
UNFPA United Nations Fund for Population Activities UNICEF United Nations Children Fund
USAID United States Agency for International Development WHO World Health Organization
1.1 Background to the study
CHAPTER ONE
INTRODUCTION
The growing concern on improving reproductive health in the global south has created a demand for research especially in the area of maternal health. Maternal health, which is the physical well being of a woman during pregnancy, childbirth, and postpartum period (WHO, 2011; Fadeyi, 2007), has been a major concern of several international summits and conferences since the late 1980s, which culminated to the Millennium Summit in 2000 (WHO, 2007). At that summit, it was generally agreed that maternal health care has a crucial role to play in the improvement of reproductive health and that women deserve to be well informed and empowered to have unhindered access to safe, effective, affordable, acceptable and appropriate health care service. These will enable them to go safely through pregnancy and child birth and provide couples with the best chance of having healthy infants (United Nations, 1996). While motherhood is often a positive and fulfilling experience, for
THE SOCIO-CULTURAL CONTEXT OF MATERNAL HEALTH IN LAGOS STATE, NIGERIA